Liver transplant

Overview of liver transplants

Why it's necessary

Liver transplants treat end-stage liver disease and other serious liver conditions. Chronic liver failure from cirrhosis (irreversible scarring of the liver) is the most common reason for a liver transplant in adults, but others include:

• Acute (sudden) liver failure, usually due to poisoning or drug overdose; acetaminophen (Tylenol) overdose is the most common cause
• Liver cancer, including hepatocellular carcinoma, hepatoblastoma, and cholangiocarcinoma
• Liver defects present at birth, including biliary atresia

Liver transplants are necessary when a person's liver is no longer functioning well enough to keep them alive. If you've been diagnosed with a chronic liver disease like alcoholic liver disease, fatty liver disease, or cirrhosis from hepatitis C, you may be a candidate for a liver transplant. You and your doctor will work together with your transplant team to get you ready for the procedure.

Common conditions treated with liver transplants

Most conditions treated with a liver transplant are chronic, or have lasted a long time. They include:

• Liver cancer
• Fatty liver disease
• Chronic hepatitis
• Wilson disease
• Diseases of the bile ducts, including primary biliary cholangitis

Occasionally patients will need a liver transplant from acute liver failure due to overdoses of acetaminophen, reactions to other prescription medicines, viral hepatitis, or blockage of the blood vessels to the liver.

Types

There are three types of liver transplant:

• Whole cadaver transplants use the entire liver from a deceased donor. The liver is not damaged and still functions properly.
• Split cadaver transplants use part of a deceased donor's liver. The donor's liver is divided in half and transplanted into two recipients, usually children or petite adults.
• Living donor transplants use a part of a living person's liver. Living donor transplants work because the liver can regrow. Living donors are usually family members or close friends.

The majority of liver transplants come from deceased donors, and the number of people waiting for livers is much larger than those that are available.

Risks

As with any surgery, there are risks with liver transplant. However, if you and your doctor have decided you are a candidate, then you've both come to the conclusion that the benefits of this surgery outweigh the risks. Risks of a liver transplant include:

• Bleeding and blood clots
• Infection
• Bile duct complications
• Rejection or failure of donated liver, which happens when the body does not recognize the new tissue and your immune system begins to attack the donor liver as an invader
• Recurrence of liver disease

Preparation

A transplant center must evaluate you to determine if you are eligible for a liver transplant. It's much easier to get a liver in an urgent or emergency situation if this has already happened. An evaluation and matching process is also necessary for a living donor transplant.

You will be placed on the national waiting list for a donor liver unless you have a living donor. A computer program determines the best candidates when a liver becomes available. It considers things like matching tissue compatibility, where you live, medical urgency, and waiting time. People with urgent conditions may get a liver before someone who is healthier but who has been waiting longer.

Surgery

It is essential to follow all pre-surgical instructions from your doctor. They will include not eating or drinking for a certain amount of time before your procedure, usually eight to 12 hours. You should also have someone bring you to and from the hospital and provide support once you are discharged.

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.